Cavernosal venocclusive insufficiency in male impotence: evaluation of degree and location.

The author's experience with 72 patients with impotence, one patient with Peyronie disease (no impotence), and two healthy volunteers indicates that incompetence of the venocclusive mechanism of the corpora cavernosa is probably the most common cause of vasculogenic impotence. Manometric and angiographic studies are the key to diagnosis but only when performed while the venocclusive mechanism is activated. Activation is achieved by intracavernosal injection of a papaverine-phentolamine mixture. Pharmacomanometry, performed with the newly developed pharmacologic maintenance erectile flow (PMEF) method, enabled precise quantitation of the leak at a given cavernosal pressure. A new appreciation of the limited volume of normal flow in the cavernosal arteries indicates that cavernosal leak in the range of only 20 ml/min is probably capable of contributing to impotence. Pharmacocavernosography enabled identification of sites of leakage (key information in the planning of surgical correction) but was unreliable in the evaluation of the severity of leakage.